He said I have a deviated septum to the left with nasal valve collapse? (Photos)

Question

I just saw ENT cause I can never breathe out if my left nostril hardly at all, if that. He said I have a deviated septum to the left with nasal valve collapse. I've had trauma to my nose several times due to sibling abuse, oh, and +3 tonsils. He ordered at CT scan looking for sinusitis versus rhinitis. I asked if he can fix my breathing, and he just said " oh yes, but need to see CT first". How can he fix this? I have tried every single thing to help myself, I can't stand it anymore.

Ritchie Younger, MD · Answer

Seek out a board certified facial plastic surgeon who has vast experience resolving  nasal airway problems.  If your nasal septum is not straight, compounded by a nasal valve problem-a thorough physical examination of your nose , which frequently includes an endoscopic exam of your airway, and any number of specific x-ray examinations-may need to be undertaken.  You may require modification of the nose through aligning the septum better, and if indeed you have a so-called collapsing valve-you may require cartilage grafts (taken from either your nasal septum or perhaps some cartilage from your ear) to reinforce your nose to reverse this quite common cause of nasal obstruction.  The surgical technology is out there to help you-just find the right surgeon to deliver it to you and achieve the nasal airway you have always wanted !!

Matthew Brace, MD · Answer

A deviated septum is easily corrected by a surgery called a septoplasty. This surgery straightens the septum. The issue of a deviated septum and nasal valve collapse requires a more involved surgery called a septorhinoplasty. This involves straightening the septum and using cartilage grafts (taken from your septum usually) placed in key areas to support your nasal soft tissue so that it does not collapse with breathing.  If your CT demonstrates sinus disease, a sinus surgery may be required as well as nasal medications to manage your nasal/sinus swelling and inflammation. Rhinitis is inflammation in your nose that requires lifestyle avoidances and nasal medications to manage the swelling and keep you breathing well.
All the best,
Dr. Brace

William Portuese, MD · Answer

A septoplasty is performed to straighten a deviated nasal septum. A spreader graft is placed underneath the upper lateral cartilage which is collapsing inward  creating the nasal valve collapse and nasal obstruction. A CAT scan is only looking for chronic sinusitis with polyps on the inside of the sinuses. It's important to try and fail medical management first before undergoing surgical intervention for these issues. Medical necessity and preauthorization must be accomplished prior to any functional nasal surgery. For more information, please see the link and the video below

Summit Kundaria, MD · Answer

bmfenf11,
Thanks for your question and pictures.  Though I am sure that there is more to this story than you were able to ask in the space provided, based on the information and pictures we have, I see that you have an anatomic blockage of your left nasal airway.  Your nasal bones are also shifted to the left, likely an old fracture.  I do not know how your tonsils fit into this picture, but a CT scan may show more anatomic blockage of the nasal airway, such as a concha bullosa, which is like a bone balloon in your nose that blocks air flow.  It appears that your ENT is thinking about doing a septoplasty, possibly repair of vestibular stenosis, if they try to get that part of your septum that is sticking into your left nasal passage, and possibly sinus surgery.  I do not know if they plan on doing your tonsils at the same time (or if this is even needed) based on the information you provided.  Depending on the exact nature of the blockage, he may also be thinking of a functional septorhinoplasty, where your nasal bones are broken and moved to a more midline position, and also addressing the asymmetries in the lower 2/3 of your nose.

The good news is that if this is an anatomic issue, there is a big limit on how far medical therapy will get you, as you can imagine that decreasing the thickness of the lining of your nose will not matter if the walls are touching each other.  The "bad" news is that you will need surgery.  I think you will have a good result and that your breathing will be much improved compared to having one side completely blocked all the time.

Good luck!!

He said I have a deviated septum to the left with nasal valve collapse? (Photos)

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